Post-Graduation Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil.
Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Community Dent Oral Epidemiol. 2019 Jun;47(3):274-280. doi: 10.1111/cdoe.12455. Epub 2019 Mar 25.
This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities.
A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log-binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut-off points for outcomes were based on state goals for public dental services. Blinder-Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status.
Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference.
This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development.
本研究旨在检验市政社会发展指标与公共牙科服务指标之间的关联；检验水氟化和非水氟化市政之间公共牙科服务目标实现的差异；并量化市政社会发展指标对水氟化和非水氟化市政之间公共牙科服务指标估计均值差异的贡献。
对巴西南部 293 个市立牙科保健服务记录进行了 2010 年至 2015 年的数据二次分析。采用多变量对数二项式回归模型检验市政人类发展指数（HDI）与多项公共牙科服务指标（公共牙科保健服务覆盖率比例、所有临床程序中拔牙比例以及每月监督刷牙参与率）之间的关联。根据公共牙科服务的州目标设定了结局的截断值。进行 Blinder-Oaxaca 分解分析，以量化 HDI 对根据市政水氟化状态差异的结果的相对贡献。
HDI 最低三分位的市政中，公共牙科保健服务覆盖率不足（低于州目标）的比例比 HDI 最高三分位的市政低 66%（PR：0.44；95%CI：0.24，0.50）。HDI 最低的市政中，拔牙和监督刷牙比例达到州目标的比例分别高出近 30%（PR：1.30；95%CI：1.20，1.40 和 PR：1.34；95%CI：1.23，1.45）。非水氟化市政的公共牙科保健服务覆盖率高于水氟化市政，市政 HDI 解释了总估计均值差异的 36%。
本研究发现了巴西南部市政社会发展与公共牙科服务指标之间的关联。然而，较高的 HDI 与较低的公共牙科保健服务覆盖率、较低的拔牙比例和较高的监督刷牙覆盖率相关[2019 年 4 月 2 日在线更正：在前面的句子中，“但是，拔牙比例较高，监督刷牙覆盖率较高”改为“拔牙比例较低，监督刷牙覆盖率较高”]。市政 HDI 显著影响水氟化和非水氟化市政之间公共牙科服务覆盖率的差距，有利于非水氟化市政。这些发现对减少口腔健康不平等具有重要政策意义，因为它强调了关键口腔健康政策及其根据市政社会发展的分配之间的相互作用。
